the high risk new born
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Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM
THE HIGH RISK NEW THE HIGH RISK NEW BORNBORN
Dr.LORN TRY Patrich,Pediatrician, Dr.LORN TRY Patrich,Pediatrician, DHMDHM
Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM
IntroductionIntroduction
A high risk is define as any neonate when A high risk is define as any neonate when is in danger of serious illness or death as a is in danger of serious illness or death as a result of prenatal,perinatal, or neonatal result of prenatal,perinatal, or neonatal conditions, regardless of birth weigh or conditions, regardless of birth weigh or gestational age.gestational age.
Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM
Condition of high riskCondition of high risk
a)a) The preterm infantThe preterm infant Respiratory problem(shallow, rapid, and Respiratory problem(shallow, rapid, and
irregular with period of apnea).irregular with period of apnea). Heat loos (cold stress)Heat loos (cold stress) Intraventricalar hemorrhage ( More often in Intraventricalar hemorrhage ( More often in
the neonate of less than 32 weeks ‘gestation the neonate of less than 32 weeks ‘gestation ( signs of possible IVH include : hypotonia, ( signs of possible IVH include : hypotonia, apnea, bradycardia, a full (or bulging) apnea, bradycardia, a full (or bulging) fontanelle, cyanosis and increased head fontanelle, cyanosis and increased head circonference, convulsion, and circonference, convulsion, and stupor) .However mild bleeds can occur stupor) .However mild bleeds can occur without these symptome.without these symptome.
Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM
Condition of high risk(Conti..)Condition of high risk(Conti..) Hyperbilirubinemia. That may result in Hyperbilirubinemia. That may result in
brain domage.brain domage. Retinopathy of prematurityRetinopathy of prematurityb/ The post term (> 42 weeks )b/ The post term (> 42 weeks )
• Litth lanugo or vernix Litth lanugo or vernix • Scal hairScal hair• Skin drySkin dry• Infant risk :Infant risk :
• HypoglycemiaHypoglycemia• PolycytemiaPolycytemia• Cerebral ischemiaCerebral ischemia• Thrombus formationThrombus formation• Respiratory distress Respiratory distress
Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM
Le terme dépasséLe terme dépassé
Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM
Condition of high risk(Conti..)Condition of high risk(Conti..)
c/ The infant of diabetic mother risk :c/ The infant of diabetic mother risk :• Hypoglycemia in first few hours after birth. Hypoglycemia in first few hours after birth.
Untreated may cause severe, irreversible Untreated may cause severe, irreversible damage to the central nervous system.damage to the central nervous system.
• Congenital anomaliesCongenital anomalies• HypocalcemiaHypocalcemia• HyperbilirubinemiaHyperbilirubinemia• Hyaline membrane diseaseHyaline membrane disease
Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM
Condition of high risk(Conti..)Condition of high risk(Conti..)
d/ The infant with neonate sepsis :d/ The infant with neonate sepsis :• Infection from Infection from
• The mother (through the placenta, vaginal infection)The mother (through the placenta, vaginal infection)• Inhalation of contaminated amniotic fluid.Inhalation of contaminated amniotic fluid.
• Any specific signsAny specific signs• CyanosisCyanosis• Thermal instabilityThermal instability• ConvulsionsConvulsions• LethargyLethargy• JaundiceJaundice• ApneaApnea
Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM
Condition of high risk(Fin)Condition of high risk(Fin)
e/Necrosing enterocolitise/Necrosing enterocolitis• Often in small preterm may occur in full term Often in small preterm may occur in full term
neonatneonat• Cause: Cause:
• Hypoxia (Poor tissue perfusion)Hypoxia (Poor tissue perfusion)• Bacterial invasion of the bowelBacterial invasion of the bowel• Clinical : Abdominal distensionClinical : Abdominal distension
f/ The infant of an HIV positive motherf/ The infant of an HIV positive mother
g/ The infant of addicted mother (Alcool, g/ The infant of addicted mother (Alcool, Cocaïne, heroïne, methadone or other Cocaïne, heroïne, methadone or other narcotic )narcotic )
Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM
PREMATUREPREMATURE5y MD IU5y MD IU
DR.LORN TRY Patrich, DR.LORN TRY Patrich, Pediatrician,DHMPediatrician,DHM
Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM
DEFINITIONDEFINITION
Premature infant is a baby borne Premature infant is a baby borne before 37 weeks gestation .before 37 weeks gestation .
At birth, a baby is classified as one At birth, a baby is classified as one the following :the following :– Premature Premature (less than 37 weeks (less than 37 weeks
gestation )gestation )– Full term Full term ( 37 to 42 weeks gestation )( 37 to 42 weeks gestation )– Post term Post term ( born after 42 weeks ( born after 42 weeks
gestation )gestation )
Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM
RISKs FACTORsRISKs FACTORs Cause of preterm labor is unknownCause of preterm labor is unknown Multiple pregnancy (twins, triplet ……. Makes Multiple pregnancy (twins, triplet ……. Makes
up about 15% of all premature births )up about 15% of all premature births ) The following health conditions and events in The following health conditions and events in
the mother may contribute to preterm labor :the mother may contribute to preterm labor :– DiabeteDiabete - Heart disease- Heart disease– Kidney diseaseKidney disease - Lake of prenatal - Lake of prenatal
carecare– Poor nutritionPoor nutrition - Preeclampsia- Preeclampsia– Substance abusSubstance abus - Young age (the mother - Young age (the mother
age younger than age younger than 18 )18 )
Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM
RISKs FACTORsRISKs FACTORs A women who has had any of the following is A women who has had any of the following is
increase risk of preterm labor :increase risk of preterm labor :– Premature rupture of the membrane or placenta Premature rupture of the membrane or placenta
previaprevia– Previous pretermPrevious preterm– Problems with the uterus or cerviProblems with the uterus or cervi– Unexplained high alpha foeto-protein level in the Unexplained high alpha foeto-protein level in the
seconde trimester .seconde trimester .– Untreated disease or infection ( such as urinary Untreated disease or infection ( such as urinary
tract infection or infection of amniotic tract infection or infection of amniotic membrane ) membrane )
Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM
EVALUATION of AGE GESTATIONEVALUATION of AGE GESTATION
Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM
Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM
Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM
The spectrum of prematurityThe spectrum of prematurity Mild prematurityMild prematurity refers to babies who are born refers to babies who are born
between 33 and 36 completed weeks between 33 and 36 completed weeks gestational age and/or have a birth weight gestational age and/or have a birth weight between 1500 and 2500 g .between 1500 and 2500 g .
Moderate prematurityModerate prematurity refers to babies who refers to babies who are born between 28 and 32 completed weeks are born between 28 and 32 completed weeks gestational age with a birth weight ranging gestational age with a birth weight ranging between 1000 and 1500 g .between 1000 and 1500 g .
Extreme prematurityExtreme prematurity refers to babies who are refers to babies who are born before 28 completed weeks gestational born before 28 completed weeks gestational age or who have a birth weight of less than age or who have a birth weight of less than 1000 g 1000 g
Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM
SYMPTOMSSYMPTOMS A premature infant has organs that are not A premature infant has organs that are not
fully developped. The infant needs special fully developped. The infant needs special care in nursery until the organ have care in nursery until the organ have developed enough to sustain life without developed enough to sustain life without medical support . This may take weeks to medical support . This may take weeks to months. Common symptoms in a months. Common symptoms in a premature infant include:premature infant include:– Body hairBody hair– Episodes of absent breathingEpisodes of absent breathing– Elarged clitoris (female infant)Elarged clitoris (female infant)– Smooth without ridges (mal infant)Smooth without ridges (mal infant)– Transparent skin ( can see veins under skin )Transparent skin ( can see veins under skin )– Weak eyWeak ey
Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM
SYMPTOMSSYMPTOMS
Common tests performed on a premature Common tests performed on a premature infant include :infant include :– Blood gas analysisBlood gas analysis– Blood test to check glucose calcium and Blood test to check glucose calcium and
bilirubine levels.bilirubine levels.– Chest X- rayChest X- ray
Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM
TREATMENTTREATMENT When premature labor develop and can not be When premature labor develop and can not be
stopped . The mother may be moved to center that stopped . The mother may be moved to center that specifically care for premature infant.specifically care for premature infant.
In some cases, medicine called steroïds may be In some cases, medicine called steroïds may be given to the mother in the help the baby ‘s lung given to the mother in the help the baby ‘s lung mature. When born, the baby is placed under mature. When born, the baby is placed under warmer.warmer.
Since infants are usually unable to coordinate Since infants are usually unable to coordinate sucking and swallowing before 34 weeks gestation, sucking and swallowing before 34 weeks gestation, your baby may have a feeding tube placed into your baby may have a feeding tube placed into stomach. In very premature infants, nutrition may stomach. In very premature infants, nutrition may be given through a vein until the baby is stable be given through a vein until the baby is stable enough to receive feeding by mouth. enough to receive feeding by mouth.
Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM
TREATMENTTREATMENT If the infant has breathing problems, a If the infant has breathing problems, a
tube may be placed in the trachea. A tube may be placed in the trachea. A machine called a respiration will help the machine called a respiration will help the baby breathe. Oxygen is given,baby breathe. Oxygen is given,
Nursery care is needed until the infant Nursery care is needed until the infant reaches a stable body weigh and is able to reaches a stable body weigh and is able to feed by mouth and maintain body feed by mouth and maintain body temperature.temperature.
Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM
Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM
COMPLICATIONCOMPLICATION AnemiaAnemia Bleeding into the brain (IVH)Bleeding into the brain (IVH) Bronchodysplasia (BPD)Bronchodysplasia (BPD) Congnitive or motor disability or delayCongnitive or motor disability or delay Delayed growth and developmentDelayed growth and development Infection or neonatal sepsisInfection or neonatal sepsis Heart disease (PDA)Heart disease (PDA) Low blood sugarLow blood sugar Newborn jaundiceNewborn jaundice Retinopathy and vision loss or blindnessRetinopathy and vision loss or blindness Severe intestinal inflammation (necrotizing Severe intestinal inflammation (necrotizing
enterocolitis)enterocolitis)
Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM
PREVENTIONPREVENTION One of the most important stepe to One of the most important stepe to
preventing prematurity is to receive preventing prematurity is to receive prenatal care as early as possible in the prenatal care as early as possible in the pregnancy, and continue such care until pregnancy, and continue such care until the baby is born.the baby is born.
Maternal treatmentMaternal treatment
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